Local reaction to health care ruling mixed

Local reaction to Thursday’s Supreme Court ruling upholding America’s historic health care overhaul – commonly referred to as “Obamacare” – was mixed.

The Affordable Care Act, certain now to touch virtually every citizen’s life, narrowly survived an election-year battle at the Supreme Court Thursday with the improbable help of conservative Chief Justice John Roberts.

The high court upheld the closely-watched individual insurance mandate that will require most Americans to obtain insurance or face a penalty. But the Supreme Court struck down part of the law that would have threatened Missouri and other states with the loss of federal Medicaid dollars if they refused to expand coverage to adults earning up to 133 percent of the federal poverty level.

But the ruling, by a 5-4 vote, also gave Republicans unexpected ammunition to energize supporters for the fall campaign against President Barack Obama, the bill’s champion – and for next year’s vigorous efforts to repeal the law as a new federal tax.

Many Republicans oppose the law, arguing that it marks a government takeover of health care at the same time it curtails Medicare spending and raises taxes. They also point to studies that predict private employers will be forced to reduce or eliminate coverage and that the legislation will wind up costing far more than estimated, raising federal deficits as a result.

Missouri Republican leaders closed the door Thursday on expanding Medicaid eligibility while taking a wait-and-see approach for a state-based online insurance marketplace after the ruling.

Now Missouri officials face two decisions: Should the state voluntarily expand Medicaid to cover more people who earn more money? And should Missouri create a state-based insurance exchange, or use one that will be run by the federal government?

Immediately after the court’s ruling, Missouri Republicans said expanding Medicaid would be unlikely and too expensive. Missouri sharply trimmed its Medicaid rolls in 2005 while facing state budget difficulties. The expansion in Missouri would cover an additional 255,000 adults, but it would cost the state $100 million or more each year starting in 2017.

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The news was met with joy by Dr. Bridget McCandless, medical director of the Shared Care Free Clinic on U.S. 24 in Independence, which serves uninsured patients who are chronically ill with existing medical conditions.

“It’s an exciting day,” she said. “This is a complicated bill, but some of the pieces that have already gone into effect have been so successful.”

For example, McCandless said, allowing adults ages 26 and younger to remain on their parents’ health insurance coverage has proven successful. The next step, she said, is covering low-income individuals through expanded Medicaid benefits. The Shared Care Free Clinic only sees patients who have no insurance coverage – those with Medicaid are eligible to see Medicaid providers instead.

“Certainly for the people I take care of, having access to Medicaid coverage would be excellent for them,” McCandless said, “both for their medical care and for their medication.”

But the ruling isn’t without its challenges, McCandless said.

“I think we’re going to be tangled up in Congress for a long time before we get to see the effects of the bill,” she said. “There is certainly the challenge of whether Congress will be willing to release the funds that enact the forces of the bill.”

One aspect of the bill that could turn out well is the insurance exchange, McCandless said, which is an electronic marketplace where people can shop for insurance and compare different insurance products.

“For people who are paying cash for their insurance policy, they’ll have a much better way to be able to shop now,” she said.

McCandless pointed out that even with Thursday’s ruling, the Shared Care Free Clinic isn’t going away any time soon.

“Even though the Supreme Court upheld it (Thursday), we still have a long way before patients will be able to use expanded Medicaid benefits,” she said. “If it turns out that no one needs my services, I would be so delighted to get them other forms of care.”

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Tom Waters, a small business owner in Independence, said the law has worked so far. He is owner of Corporate Copy Print, an Independence business with 10 employees. The company has been in business for 18 years and has always offered health insurance to its employees.

Health-care rules and regulations are constantly changing, and he largely relies on his accountant and insurance agent to help him navigate through those. There are pluses and minuses, but “the law so far has been to our benefit.”

Waters himself has been off for a couple of weeks for surgery.

“Through this process, I couldn’t help but think about those without health coverage who probably need it.”

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Pam Baker, a co-owner of Tropical Xtreme Tanz in Blue Springs, has been living with the impact of the health care act since 2010, paying an extra 10 percent tax the bill requires of tanning salons.

“I didn’t have a choice, and that bothered me when it happened,” Baker said Thursday.

“It gets us pretty good,” she said of the tax, which totals about $3,000 every three months.

By taxing tanning salons, the provision aimed to solve two issues: to help fund the bill and to discourage indoor tanning for health reasons.

Studies from the International Agency for Research on Cancer suggest that the risk of melanoma increases by 75 percent when people begin tanning before the age of 35.

When her business was forced to pay the additional , Baker said they had been poised to hire additional personnel, but they scrapped that idea.

As to the requiement that citizens purchase health insurance, Baker said she disagrees with it.

“It’s just stupid,” she said.

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Roberts’ vote, along with those of the court’s four liberal justices, preserved the largest expansion of the nation’s social safety net in more than 45 years, including the hotly debated core requirement that nearly everyone have health insurance or pay a penalty. The aim is to extend coverage to more than 30 million people who now are uninsured.

The decision meant the huge overhaul, still taking effect, could proceed and pick up momentum over the next several years, with an impact on the way that countless Americans receive and pay for their personal medical care.

The ruling handed Obama a campaign-season victory in rejecting arguments that Congress went too far in approving the plan. However, Republicans quickly indicated they would try to use the decision against him.

At the White House, Obama declared, “Whatever the politics, today’s decision was a victory for people all over this country.” Blocks away, GOP presidential candidate Mitt Romney renewed his criticism of the overhaul, calling it “bad law” and promising to work to repeal it if elected in November.

Breaking with the other conservative justices, Roberts wrote the judgment that allows the law to go forward. He explained at length the court’s view of the insurance mandate as a valid exercise of Congress’ authority to “lay and collect taxes.” The administration estimates that roughly 4 million people will pay the penalty rather than buy insurance.

Missouri Republican Lt. Gov. Peter Kinder said the Medicaid expansion would have been “a break-the-bank provision for the state of Missouri.” Kinder, who in 2010 filed his own, separate legal challenge to the federal health care law, pledged Thursday to continue fighting.

Nonetheless, some advocates said expanding eligibility for Medicaid would help. Missouri Health Advocacy Alliance executive director Andrea Routh said the coalition of mostly consumer groups and health care providers would push for coverage of more people.

“It’s really important that that Medicaid piece be implemented in Missouri. It’s really designed to give those low-income families coverage in a way that is organized and we can track the spending,” Routh said.

Missouri had about 835,000 uninsured residents in 2010, about 14 percent of the population, according to the U.S. Census Bureau.

Democratic Gov. Jay Nixon made expanding eligibility for the state’s Medicaid rolls a major theme of his 2008 election bid, but he declined to comment about it Thursday. Instead, Nixon said his administration is reviewing the high court’s ruling and that he is “committed to working collaboratively with citizens, businesses, medical providers and the Legislature to move forward in a way that works best for families in our state.”

Missouri voters will decide this fall on a measure that would allow a state-created insurance exchange only if it is specifically authorized by a state law or a subsequent vote of the people. It would prohibit the governor or any executive branch officials from taking any steps toward establishing an exchange on their own. House Majority Leader Tim Jones added that if Romney defeats Obama, he believes Romney would suspend the requirement to have health insurance exchanges in each state.

Rep. Chris Moldendorp said legislative leaders should immediately appoint a committee to study a health insurance exchange and approve the creation of one in January. Molendorp, a Republican, operates an insurance agency in Raymore and in 2011 sponsored legislation to establish a state insurance exchange.

“Exercising your last shred of sovereignty, exercising states’ rights to control their marketplace – that is a conservative, prudent, responsible action by a citizen legislator,” he said.

Adrianne DeWeese, Jeff Fox and Jeff Martin of The Examiner and Mark Sherman, David Lieb and Chris Blank of The Associated Press contributed to this report.